694 PELVIC FLOOR DYSFUNCTION IN CHILDREN WITH CHRONIC CONSTIPATION

Abstract

We have previously shown that some children with chronic constipation and encopresis (P) have impairment of rectal sensation. 23 consecutive P (constipation ≥ 1 year) and 8 healthy controls (H), 4-13 yr old, were asked to defecate water-filled balloons containing 30, 50 and 100 ml water, while sitting on a toilet chair. 12 P (Pdef+) and all H defecated all 3 balloons, whereas 11 P (Pdef-) defecated 1 or no balloons. We evaluated EMG activity of the external anal sphincter/pelvic floor during defecation while lying down. The mean anal pullthrough pressure (mm Hg) during rest (APr) and during squeeze (APsq) were obtained using intraluminal transducers. Threshold of rectal sensation (Tsens), threshold of the rectosphincteric reflex (TRSR), and the rectal volume (ml of air) which produced an urge to defecate (CV) were measured by distending a rectal balloon. All H had decreased EMG activity during trials to defecate. The pelvic floor showed increased EMG activity in 17% Pdef+ compared to 82% Pdef- (P<0.03).

APr and APsq were not different in the 3 groups. Tsens, TRSR and CV were significantly increased in both constipated groups when compared to H (p<0.05). This study indicates that 48% of P have a motor abnormality of the pelvic floor rendering it unable to relax during attempted defecation.

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